ILEAL PERFORATION IN A CHILD WITH DISSEMINATED TB
Author: Pediatric Oncall
Question.
An 8 years old boy presented with dry cough and low grade fever for 6 months, constipation for 2 months with pain on left side of abdomen for 1 month. Uncle had tuberculosis and had died due to same. On examination, he had tenderness in left lumbar region and other systems were normal. He was malnourished with a weight of 14 kg. Chest X-Ray was normal. Ultrasound abdomen showed mild hepatosplenomegaly with long segment thickening of bowel and enlarged mesenteric lymphnodes. HIV ELISA was negative. He was started on antituberculous therapy {ATT}. Three months after ATT, he had ileal perforation and required surgery. A lymphnode biopsy did not grow any acid fast bacilli {AFB} after 6 weeks of culture. He was started on steroids in view of intestinal adhesions and responded to same.
Answers of this discussion
Author :- mona kasemc on 21 December 2011.
Answer :- yes it should be used with anti tb drugs in severe cases like this

Author :- amany H mousa on 24 December 2011.
Answer :- steroid may be allowed for short course and extent of the ATT for 6 -12 months

Author :- gotur ramulu on 24 December 2011.
Answer :- yes,steroids can be given with anti tb therapy.

Author :- a Ma Elena Calderon on 24 December 2011.
Answer :- Yes, for avoid adherences

Author :- Dilek Dilli on 26 December 2011.
Answer :- yes, steroids will resolve granulomatous reaction and fibrosis with its antiinflammatory effect

Author :- Praveen B K on 26 December 2011.
Answer :- Was IBD ruled out_?

Author :- fificash ad on 27 December 2011.
Answer :- yes` in such severe cases give steroids with intensive anti-tuberculis therapy

Author :- SRINIVAS RAVURI on 29 December 2011.
Answer :- yes steroids can be used in such cases ,but only intestinal tuberculosis doesnt require steroids as aroutine

Author :- khuteja fatima on 01 January 2012.
Answer :- NO IT WOLD WORSEN THE CONDITION DISSEMINATION OF TB and DELAYED HEALING OF PERFORATION OCCURS

Author :- SRINIVAS RAVURI on 02 January 2012.
Answer :- steroids are not indicated in treatment of or for preventing intestinal adhesions

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